Representative Michelle Caldier: 2018 Citizen of the Year
Each year, the WSDA chooses one of its own to honor as its Citizen of the Year. The award is bestowed upon a member who has performed outstanding service to help a community in need, reinforce the value of service to the dental community, and promote the image of dentistry. This year's recipient is Representative Michelle Caldier.
Each year, the WSDA chooses one of its own to honor as its Citizen of the Year. The award is bestowed upon a member who has performed outstanding service to help a community in need, reinforce the value of service to the dental community, and promote the image of dentistry. This year, the Task Force on Recognition chose Representative Michelle Caldier (R-Port Orchard) for its highest honor, not only because of her generosity in donating $1 million in uncompensated care in the course of her dental career, but because of her work as a tireless advocate for the most vulnerable populations as a legislator, and her generosity of spirit as a foster mother. As a state representative, Caldier has written or sponsored more than 30 pieces of legislation, many of which aimed to help at-risk and underserved communities she has championed all her life. WSDA President Dr. Cindy Pauley said, “As a sitting member of the Health and Wellness Committee she works every day to advocate for patient rights, always ensuring that dental patients in Washington state are served with the highest quality care our profession can provide. Dr. Caldier is a true example of what a public servant embodies.”
Caldier is the first dentist in Washington state elected to the Legislature, but her service to others stretches far beyond the realm of dentistry. She has made it her cause to protect those with no voice — children, the elderly, and the infirmed. Her work in the legislature on behalf of foster children, survivors of rape, and adult Medicaid recipients have made her a voice to reckon with in her short time in Olympia. Caldier’s passion for the foster system is genuine and personal — she was placed in the foster system as a child, and later became a foster parent. Caldier is the proud mother of her daughter Cassandra and to her two foster daughters, Alicia and Sophia. Caldier has seen the foster system’s failings from the inside and knows what work needs to be done to fix some of its many problems. Her work supporting education is equally laser-focused
A lifelong resident of Kitsap County, Caldier is proud to say that she graduated from Central Kitsap High School, and earned her Bachelor of Science degree in Cell and Molecular Biology from the University of Washington. She graduated from the UW School of Dentistry in 2001. She served as an affiliate professor there from 2004-2015, teaching in the school’s geriatric department, giving back to the University that so enriched her life.
Prospering in spite of a troubled youth
Caldier’s early life story isn’t one we typically hear from dentists. She is the fourth generation of her family to call Kitsap County home. When she was 9 years old her mother divorced her father and married a man who brutally abused Caldier and her siblings. She explained, “Our stepfather was not only physically and emotionally abusive, but sexually abusive, as well. I was in and out of the foster system from ages 10 to 17. I lived with a couple of different families and wound up being out on my own at 17. I worked three jobs, and I took care of my sister who was 14 and pregnant, and her friend. Even before I got into the foster system, I was heavily ‘parentified’ because I had to care for my three younger sisters. There was no one else to care for them.” Caldier’s life could easily have spiraled out, but she was determined, bright, and focused. She had a goal from an early age — to become a dentist — and she was resolute. Caldier recalled, “My childhood dentist was Dr. Pebbles, and growing up one of my best memories was going to his office because they were so nice to me. His receptionist, Shelly, would always tell me that I was so good that I could have an extra toy. Since I can remember, I have always said that I wanted to be a dentist. That was one of the things that helped me through when times were bad.”
It was a tough road, and at times Caldier felt she had few allies. By her teenage years, she had more travails than most people amass in a lifetime. But even as she bounced from foster home to foster home, she made sure she stayed in the same junior high and high schools. “I had great relationships with my teachers, and they were really who helped me and shaped me to become who I am,” she said. “Because of them I went down the right path.”
Proper guidance
Caldier found herself in the crosshairs again in high school. Her home life wasn’t stable, she was working, and she frequently missed school. Fortunately, her high school principal had been the counselor at her junior high, and he knew three things about Caldier: she was intelligent, life had dealt her a bad hand, and she needed a way to pull herself out. Rather than suspend her for truancy, he made her enroll in the Running Start program, which allows 11th and 12th grade students to earn high school and college credits simultaneously. She spent her senior year at the community college, which suited her independent spirit. “It put me on the right path,” Caldier said. “I’ve always felt that if I hadn’t had those relationships with my teachers and the principal, he might have chosen to kick me out and say that he was done. That’s what happens to a lot of kids. But because we had that relationship, he worked to help me create a better life.” But Caldier’s challenges continued. The program was tough, and then at age 19, she became pregnant, right when she was applying for dental school. “It was incredibly difficult,” Caldier recalled. “I had my dental school interview 14 days after I delivered my daughter, and I didn’t necessarily tell them that I had just had a child. I was very lucky that I got accepted. And so, even though I had a very rocky start, one of the things I learned was that it was important to make good friends and rely on those friendships to help me through. I had a lot of friends who helped out with my daughter. Everyone in my class at UWSoD remembers me because I had my daughter there a lot. It was tough, but I have never shied away from hard work, and I knew that I wanted her to have a better life than I had.” Dr. Dolphine Oda, a professor at the School or Dentistry who has known Caldier for more than 20 years, recalled, “Back at the UWSoD, Michelle was an enthusiastic, serious student who earned her dental degree the old-fashioned way, through intelligence, commitment, and honest hard work. She was always positive and forward looking, and showed the ability to handle challenges with grace and maturity. Overall, she was a model student.”
The road to mobile dentistry
Caldier stumbled upon her idea for a mobile practice following a geriatric rotation in dental school. She saw a need that wasn’t being met, and was determined to make that her life’s work. “I didn’t know if anyone else was doing it, and I started looking into the different types of mobile equipment,” she explained. In fact, when Caldier graduated from the UWSoD, mobile dentistry wasn’t really even a practice model. There was no blueprint for it because no one was doing it, and the available equipment was subpar. Caldier worked to change all that. Her practice, Golden Age Dentistry, was both innovative and important because it reached a population that was largely an afterthought: residents of nursing homes and homebound patients. Many of these patients aren’t mobile enough to leave their room or home, while others suffer from dementia and/or a host of medical problems. Even though many people have the means to pay for dental care, few providers are able to treat this population. “It would have been easy for her to develop a lucrative private dental practice like most of her fellow UW dentistry graduates,” said Oda. “Instead, she chose to devote her professional efforts to serving the community, including those unable to afford dental care, treating them in her mobile dentistry practice.”
Additionally, the equipment available to Caldier at the time was underpowered and inefficient. As they say, necessity is the mother of invention, and after a lot of improvisation, she took matters into her own hands. She explained, “I bought some equipment, and I wasn’t happy with it, so I began to call the manufacturers like Aseptico to see what they could do to improve the quality.” Caldier had a dental chair welded to a base to make it portable, employed a driver who took care of delivering her equipment to the nursing homes and setting it up before she arrived, and had either one or two assistants with her, depending on the flow of the day. It was imperative that nursing home staff had the mechanical lifts to get patients in and out of the chair. Caldier said, “I absolutely had to be flexible in this business model, but that didn’t mean I had to lower my standards. I always had the philosophy of treating everyone the way I would want my grandfather treated. In fact, my grandfather got severe dementia towards the end of his life, and I ended up going into his home and doing work on him as well.”
The model had other challenges, as well. Initially, Caldier had to figure out how to deal with Medicaid regulations and prioritize patients’ emergent needs over those that could wait. Typically, nursing homes were understaffed, and with frequent employee turnover, making interim care difficult. That prompted Caldier to start the Nursing Home Healthy Smiles program, an educational initiative designed to teach staff how to meet patients’ daily dental needs. She explained, “When I first started, I would leave lots of things with the staff, like proxabrushes and floss to go under bridges. I would show them how to use them, and write notes in their charts. But what I found out was that the staff would throw everything out after I left, and hope I didn’t notice on my next visit. When I asked them why they did it, they said that what I was asking for wasn’t realistic. So I asked them what was realistic. They went through what their day was like, and I learned that most of the people could barely reach the sink to spit out the toothpaste, making it quite difficult to help someone brush. To help ensure success, I trained staff to make sure there wasn’t food trapped or packed in the vestibule, I started prescribing chlorhexidine instead of toothpaste because it is an antibacterial that doesn’t have a foaming agent, and I taught them how to clean interproximally by changing the brush angle. I also taught them how to take care of someone and ensure that they weren’t getting bitten or spit on, which was a common issue. I found that if you follow up and provide the staff with the right tools, the caries rate declines drastically, so it was worth it.” The program was so good that in 2011, Caldier was an ADA Adult Preventative Care Practice of the Year finalist. Pauley said, “Dr. Caldier is a shining example of what it means to truly give back to your community. In her dental career she has been a pioneer of innovation. She creatively and proactively worked to bring optimum dental health to an often underserved and overlooked nursing home population. The creative model she developed has brought dental health to thousands of patients who would otherwise suffer needlessly from dental disease.” Through hard work and determination, Caldier was able to build the practice and make a name for herself in the community. She offered all of the nursing home patients one free evaluation and cleaning a year, which helped to slow the caries rate and allowed her to keep up with the decay in their mouths. She truly loved the work and the people she was treating, and liked the freedom it provided. She said, “The one thing that is wonderful about that patient population is that, for the most part, they’re very flexible with their time. That was part of the appeal. People who know me know that I have issues with time management. I tend to run a little late, so working in the nursing homes was absolutely perfect for me. You still have to follow a schedule, but there was a little more flexibility compared to a typical practice. It fit my personality very well.”
Dr. Shane Ness, who worked with Caldier in the practice, said, “She struck me as a person full of energy, positivity, and a sense of obligation and duty to care for the people in our community that are all too easy to forget about. I’m not going to lie. Working on the patients she and I served was extremely challenging. I struggled mightily to adapt to the challenges faced every day with patients living with Alzheimer’s disease, medical fragility, aspiration risks, and immobility. There was a difference between Michelle and me, though. She seemed, and indeed was, completely confident and comfortable in the most challenging scenarios, and seemed so philosophically at peace with who she was as a provider, that it gave me the confidence to emulate her. I’ve known Michelle for over a decade now, and I’ve learned she has a special gift that allows her to do the things she does: passion.”
Mobile dentistry was more than just a good practice model fit for Caldier. It amplified her staunch support of underserved people, and planted the seed for her to go into public service. She explained, “Originally, I was a Medicaid provider, and I was extremely frustrated like many Medicaid providers. Not only with the low reimbursement rates, but the rules and regulations were onerous.” When the state cut adult dental Medicaid reimbursements, it required Caldier to focus on pressing issues, offer evaluations and cleanings at no cost, perform extractions to get patients out of pain, and tackle urgent issues like denture adjustments. She said, “A lot of our time was spent on prior authorizations and fighting to get Medicaid to reimburse. Once we dropped Medicaid, we didn’t have to waste all of that time fighting them for money. It actually wound up being a lot better. Some of my nursing homes did not have any Medicaid patients. My homes where people were not on Medicaid funded the business, and allowed us to donate care to those with no money.” Other things helped, too. Because she didn’t have a brick-and-mortar practice, her overhead was low. Staffing costs also were less expensive for Caldier. She bought equipment as needed, so she had no debt. “On top of that, I wasn’t a preferred provider for any insurance,” she said, “so it was a very different model. It was kind of a blessing because when it came to fighting Delta Dental and being vocal against some of their practices, I didn’t have to fear retaliation for speaking out against them. Additionally, I didn’t have to discount my rates. I had the liberty to donate a lot of services. Quite honestly, when it comes down to someone who is in pain and needs a tooth taken out, any dentist would donate the care. For me, my biggest thing was at least offering the preventative service and getting people out of infection or pain.”
Elected to office
Cathy Dahlquist, a former state representative who is now Executive Director for the Seattle-King County Dental Society, remembers meeting Caldier for the first time. “I was taking a tour of the UW School of Dentistry. At the time, I was an elected Washington state representative, and my nephew was planning on attending the school in the fall of that year. Dr. Caldier and I ended up going to lunch because she wanted me to hear about the program she had created to treat the elderly who were living in nursing homes. I listened intently and took her message of the need to reinstate adult dental Medicaid back to Olympia. She did not give up. She visited Olympia several times that session, and we worked together to successfully bring back the program.” Dahlquist and others convinced Caldier to run for office, based on the strength of her conviction to fight for the underserved. Since being elected, Caldier has used her platform to advocate for vulnerable populations like foster children, the developmentally disabled, and the elderly, prioritizing education, fighting unfair insurance practices, and advocating on behalf of her constituents and organized dentistry. She helped defeat legislation that would have allowed for midlevel practitioners in the state, and continues to work to raise reimbursement rates for adult dental Medicaid and change its prior authorization process.
The legislation that Caldier is most proud of is the bill requiring nonprofit insurance companies with paid boards to have the salaries of the CEO and the five highest-paid employees determined by the ratepayers. Caldier said this legislation shines light on some of the practices of the big insurance companies. “For instance,” she explained, “Delta Dental was paying Executive Director Jim Dwyer $1.3 million, and in two years it went up to $2.7 million. Delta Dental would justify its actions by saying that they had a study done showing that it was okay to increase his salary by that amount, yet at the same time, their board was also being paid, and one of the board members was making $480,000 a year, according to the IRS.” Caldier noted that many state legislators had no idea what was happening in the insurance industry, and she was proud to be the one to “…shoot an arrow into some of the most egregious things that Delta Dental was doing….” Rep. Liz Pike, R-Camas, said, “Since being sworn into office, Rep. Caldier has prime sponsored bills on fair dental insurance practices, reforming Medicaid prior authorization processes, requiring ratepayers to establish chief executive officer and board salaries for nonprofit insurance companies, and requiring dental insurance companies to be transparent with their communication to patients in their explanation of benefits form. One of Rep. Caldier’s greatest assets is her ability to stay focused on the issues and work across the aisle to get things done. She is highly respected by both Democrats and Republicans in Olympia. During that process, she is continually advocating to legislators on a variety of dental issues. And her work does not end when session is over. She is working on behalf of her constituents and dentistry all year long.”
Caldier has much to be proud of, including her work on behalf of her constituents, which has helped bring $42 million to her district, funding transportation projects and supporting environmental issues, and her efforts behind the scenes to help constituents that most people never hear about. But serving as a legislator doesn’t mean you always get your way, no matter how hard you fight. Caldier said, “As a dentist, I would write a treatment plan, and I would accomplish it. And every now and then, the patient behavior was different, so you had to modify the plan. In Olympia, you write what you’re going to do, you make a plan, but you have 146 other people you have to work with, and that’s just the legislators. That doesn’t include the lobbyists or anyone else. It’s five steps forward, four steps back. Whereas in private practice, you can make five steps forward, and maybe every now and then you have to take a step back. Olympia is slow-moving because there are so many things in play, and you don’t always get a win. There were more than 4,000 bills introduced during the 2017–18 biennia, and since 2018 was the first year that the Democrats had control of the Senate in five years, all of the Democrats had bills that they wanted put forward. It was intense, and it meant that even great bipartisan bills like my sexual assault bill didn’t go through, while some bills of little substance did.”
Leaving dentistry to focus on being a legislator
As you might imagine, balancing the work of a state representative and a dentist can be very tough. “A lot of people told me doing both would be manageable, but in the end, my duties in the Legislature didn’t stop when the session was over,” Caldier said, with a laugh. “Once I was elected to office, from January to May, I had only five days that I wasn’t working more than 14 hours. It was incredibly difficult navigating the dental practice with my position as legislator. The nice thing was that my practice was already established, so there was somewhat less work than when I first started practicing. I find it hard to imagine that someone in private practice could do both jobs.” In fact, Caldier retired from dentistry in 2016. Regardless, she remains as devoted as ever to fighting for organized dentistry. Oda, who is delighted she’s staying put, said “Our state would be a far better place if it had more citizens, and particularly more leaders, like Michelle Caldier. She labors tirelessly and selflessly for others, is scrupulously honest, always tries to do the right thing, believes the government should be transparent and serve its constituents, and sets a lifelong example of helping the state’s most vulnerable. Her ethics are stainless and her reputation is above reproach.”
Bringing the voice of dentistry to Olympia
Dentists around the state celebrated Caldier’s election in 2014 (she took office in 2015). From midlevel providers, to insurance regulation, to Medicaid coverage, dentistry has long lacked a voice in the Legislature. Pauley said, “Having Dr. Caldier in elected office with her expertise in the dental field is a luxury that patients across the state will be forever grateful for.” As a member of the Health Care Committee (she also sits on the Education and Appropriations committees), Caldier brings her unique perspective to the discussion on medical and dental issues. Legislators are constantly being bombarded with conflicting messages from paid lobbyists, and others have their own agenda, making it difficult to navigate and discern facts versus spin, according to Caldier. Case in point: the legislation being proposed to curb opioid abuse in the state. There is a lot of pressure on legislators to do something about the crisis, and myriad stories about opioid addiction and dentists’ role in the crisis crowding the news don’t help. “But it’s important that whatever legislators do, it is well thought out, and that we look at how that could impact everybody,” Caldier said. “Some people proposed that prescribers give a three-day supply or a pill limit of 10. As one of few members in the Legislature who has ever prescribed opioids, I was fighting to make sure that whatever we put forward took other situations into consideration. For instance, how would a three-day limit affect someone with chronic pain? How do we make sure we’re not lumping all opioids together? There is a huge difference between a fentanyl patch and Robitussin AC, yet Robitussin AC is an opioid, something most Legislators didn’t realize. If we have a pill limit, there is a difference between prescribing for someone who weighs 100 pounds versus 300 pounds. What about people who have just had major surgery and can’t go in every three days? It’s a very complicated issue, and I think it’s important to look at all of the pieces of the puzzle, not just one piece of the data. I felt like I did a great job of being at the table, and when some people would put forward very extreme ideas, I was able to counteract their argument. Sometimes we hear a story and we want to react, but if we do that, there could well be unintended circumstances.”
Back in the foster system and in the running
This year, Caldier added even more to her plate: she’s going to participate in the foster system again. Caldier let her license lapse years ago because of her frustration with the children’s administration when she was caring for her second foster daughter. “I needed a break,” she explained. “And now that we’ve passed some of these large pieces of legislation like HB 1855 which waives local requirements for foster children, many of those problems that frustrated me have been solved. I won’t be able to do long-term care because my work in the Legislature takes so much time, but I can do respite care for other foster parents, which gives them a short-term break from the foster children in their care. I want to see on the ground floor how the policies we’ve implemented work in a real-world setting. As legislators, we sometimes pat ourselves on the back for the work we do, but then what happens in the real world is totally different. I want to make sure that what we’re passing is actually being executed for the people who are taking care of our foster youth.”
Additionally, Caldier is running for re-election this year, and while she’s facing challengers, she’s resolute. She said, “I remember what it felt like to not have a lot, and to be judged. I also remember what it felt like when people went out of their way to fight for me. And that’s the thing. Throughout my childhood, when things were really tough, some negative people told me I would never make it in life. They didn’t expect me to graduate, and they thought it was funny that I wanted to be a dentist. But I also had a lot people who took the time to get to know me and support me. I want to be here for the people who may not have a champion fighting for them.”
Congratulations Rep. Caldier, we’re proud to have you as our Citizen of the Year!
Caldier is the first dentist in Washington state elected to the Legislature, but her service to others stretches far beyond the realm of dentistry. She has made it her cause to protect those with no voice — children, the elderly, and the infirmed. Her work in the legislature on behalf of foster children, survivors of rape, and adult Medicaid recipients have made her a voice to reckon with in her short time in Olympia. Caldier’s passion for the foster system is genuine and personal — she was placed in the foster system as a child, and later became a foster parent. Caldier is the proud mother of her daughter Cassandra and to her two foster daughters, Alicia and Sophia. Caldier has seen the foster system’s failings from the inside and knows what work needs to be done to fix some of its many problems. Her work supporting education is equally laser-focused
A lifelong resident of Kitsap County, Caldier is proud to say that she graduated from Central Kitsap High School, and earned her Bachelor of Science degree in Cell and Molecular Biology from the University of Washington. She graduated from the UW School of Dentistry in 2001. She served as an affiliate professor there from 2004-2015, teaching in the school’s geriatric department, giving back to the University that so enriched her life.
Prospering in spite of a troubled youth
Caldier’s early life story isn’t one we typically hear from dentists. She is the fourth generation of her family to call Kitsap County home. When she was 9 years old her mother divorced her father and married a man who brutally abused Caldier and her siblings. She explained, “Our stepfather was not only physically and emotionally abusive, but sexually abusive, as well. I was in and out of the foster system from ages 10 to 17. I lived with a couple of different families and wound up being out on my own at 17. I worked three jobs, and I took care of my sister who was 14 and pregnant, and her friend. Even before I got into the foster system, I was heavily ‘parentified’ because I had to care for my three younger sisters. There was no one else to care for them.” Caldier’s life could easily have spiraled out, but she was determined, bright, and focused. She had a goal from an early age — to become a dentist — and she was resolute. Caldier recalled, “My childhood dentist was Dr. Pebbles, and growing up one of my best memories was going to his office because they were so nice to me. His receptionist, Shelly, would always tell me that I was so good that I could have an extra toy. Since I can remember, I have always said that I wanted to be a dentist. That was one of the things that helped me through when times were bad.”
It was a tough road, and at times Caldier felt she had few allies. By her teenage years, she had more travails than most people amass in a lifetime. But even as she bounced from foster home to foster home, she made sure she stayed in the same junior high and high schools. “I had great relationships with my teachers, and they were really who helped me and shaped me to become who I am,” she said. “Because of them I went down the right path.”
Proper guidance
Caldier found herself in the crosshairs again in high school. Her home life wasn’t stable, she was working, and she frequently missed school. Fortunately, her high school principal had been the counselor at her junior high, and he knew three things about Caldier: she was intelligent, life had dealt her a bad hand, and she needed a way to pull herself out. Rather than suspend her for truancy, he made her enroll in the Running Start program, which allows 11th and 12th grade students to earn high school and college credits simultaneously. She spent her senior year at the community college, which suited her independent spirit. “It put me on the right path,” Caldier said. “I’ve always felt that if I hadn’t had those relationships with my teachers and the principal, he might have chosen to kick me out and say that he was done. That’s what happens to a lot of kids. But because we had that relationship, he worked to help me create a better life.” But Caldier’s challenges continued. The program was tough, and then at age 19, she became pregnant, right when she was applying for dental school. “It was incredibly difficult,” Caldier recalled. “I had my dental school interview 14 days after I delivered my daughter, and I didn’t necessarily tell them that I had just had a child. I was very lucky that I got accepted. And so, even though I had a very rocky start, one of the things I learned was that it was important to make good friends and rely on those friendships to help me through. I had a lot of friends who helped out with my daughter. Everyone in my class at UWSoD remembers me because I had my daughter there a lot. It was tough, but I have never shied away from hard work, and I knew that I wanted her to have a better life than I had.” Dr. Dolphine Oda, a professor at the School or Dentistry who has known Caldier for more than 20 years, recalled, “Back at the UWSoD, Michelle was an enthusiastic, serious student who earned her dental degree the old-fashioned way, through intelligence, commitment, and honest hard work. She was always positive and forward looking, and showed the ability to handle challenges with grace and maturity. Overall, she was a model student.”
The road to mobile dentistry
Caldier stumbled upon her idea for a mobile practice following a geriatric rotation in dental school. She saw a need that wasn’t being met, and was determined to make that her life’s work. “I didn’t know if anyone else was doing it, and I started looking into the different types of mobile equipment,” she explained. In fact, when Caldier graduated from the UWSoD, mobile dentistry wasn’t really even a practice model. There was no blueprint for it because no one was doing it, and the available equipment was subpar. Caldier worked to change all that. Her practice, Golden Age Dentistry, was both innovative and important because it reached a population that was largely an afterthought: residents of nursing homes and homebound patients. Many of these patients aren’t mobile enough to leave their room or home, while others suffer from dementia and/or a host of medical problems. Even though many people have the means to pay for dental care, few providers are able to treat this population. “It would have been easy for her to develop a lucrative private dental practice like most of her fellow UW dentistry graduates,” said Oda. “Instead, she chose to devote her professional efforts to serving the community, including those unable to afford dental care, treating them in her mobile dentistry practice.”
Additionally, the equipment available to Caldier at the time was underpowered and inefficient. As they say, necessity is the mother of invention, and after a lot of improvisation, she took matters into her own hands. She explained, “I bought some equipment, and I wasn’t happy with it, so I began to call the manufacturers like Aseptico to see what they could do to improve the quality.” Caldier had a dental chair welded to a base to make it portable, employed a driver who took care of delivering her equipment to the nursing homes and setting it up before she arrived, and had either one or two assistants with her, depending on the flow of the day. It was imperative that nursing home staff had the mechanical lifts to get patients in and out of the chair. Caldier said, “I absolutely had to be flexible in this business model, but that didn’t mean I had to lower my standards. I always had the philosophy of treating everyone the way I would want my grandfather treated. In fact, my grandfather got severe dementia towards the end of his life, and I ended up going into his home and doing work on him as well.”
The model had other challenges, as well. Initially, Caldier had to figure out how to deal with Medicaid regulations and prioritize patients’ emergent needs over those that could wait. Typically, nursing homes were understaffed, and with frequent employee turnover, making interim care difficult. That prompted Caldier to start the Nursing Home Healthy Smiles program, an educational initiative designed to teach staff how to meet patients’ daily dental needs. She explained, “When I first started, I would leave lots of things with the staff, like proxabrushes and floss to go under bridges. I would show them how to use them, and write notes in their charts. But what I found out was that the staff would throw everything out after I left, and hope I didn’t notice on my next visit. When I asked them why they did it, they said that what I was asking for wasn’t realistic. So I asked them what was realistic. They went through what their day was like, and I learned that most of the people could barely reach the sink to spit out the toothpaste, making it quite difficult to help someone brush. To help ensure success, I trained staff to make sure there wasn’t food trapped or packed in the vestibule, I started prescribing chlorhexidine instead of toothpaste because it is an antibacterial that doesn’t have a foaming agent, and I taught them how to clean interproximally by changing the brush angle. I also taught them how to take care of someone and ensure that they weren’t getting bitten or spit on, which was a common issue. I found that if you follow up and provide the staff with the right tools, the caries rate declines drastically, so it was worth it.” The program was so good that in 2011, Caldier was an ADA Adult Preventative Care Practice of the Year finalist. Pauley said, “Dr. Caldier is a shining example of what it means to truly give back to your community. In her dental career she has been a pioneer of innovation. She creatively and proactively worked to bring optimum dental health to an often underserved and overlooked nursing home population. The creative model she developed has brought dental health to thousands of patients who would otherwise suffer needlessly from dental disease.” Through hard work and determination, Caldier was able to build the practice and make a name for herself in the community. She offered all of the nursing home patients one free evaluation and cleaning a year, which helped to slow the caries rate and allowed her to keep up with the decay in their mouths. She truly loved the work and the people she was treating, and liked the freedom it provided. She said, “The one thing that is wonderful about that patient population is that, for the most part, they’re very flexible with their time. That was part of the appeal. People who know me know that I have issues with time management. I tend to run a little late, so working in the nursing homes was absolutely perfect for me. You still have to follow a schedule, but there was a little more flexibility compared to a typical practice. It fit my personality very well.”
Dr. Shane Ness, who worked with Caldier in the practice, said, “She struck me as a person full of energy, positivity, and a sense of obligation and duty to care for the people in our community that are all too easy to forget about. I’m not going to lie. Working on the patients she and I served was extremely challenging. I struggled mightily to adapt to the challenges faced every day with patients living with Alzheimer’s disease, medical fragility, aspiration risks, and immobility. There was a difference between Michelle and me, though. She seemed, and indeed was, completely confident and comfortable in the most challenging scenarios, and seemed so philosophically at peace with who she was as a provider, that it gave me the confidence to emulate her. I’ve known Michelle for over a decade now, and I’ve learned she has a special gift that allows her to do the things she does: passion.”
Mobile dentistry was more than just a good practice model fit for Caldier. It amplified her staunch support of underserved people, and planted the seed for her to go into public service. She explained, “Originally, I was a Medicaid provider, and I was extremely frustrated like many Medicaid providers. Not only with the low reimbursement rates, but the rules and regulations were onerous.” When the state cut adult dental Medicaid reimbursements, it required Caldier to focus on pressing issues, offer evaluations and cleanings at no cost, perform extractions to get patients out of pain, and tackle urgent issues like denture adjustments. She said, “A lot of our time was spent on prior authorizations and fighting to get Medicaid to reimburse. Once we dropped Medicaid, we didn’t have to waste all of that time fighting them for money. It actually wound up being a lot better. Some of my nursing homes did not have any Medicaid patients. My homes where people were not on Medicaid funded the business, and allowed us to donate care to those with no money.” Other things helped, too. Because she didn’t have a brick-and-mortar practice, her overhead was low. Staffing costs also were less expensive for Caldier. She bought equipment as needed, so she had no debt. “On top of that, I wasn’t a preferred provider for any insurance,” she said, “so it was a very different model. It was kind of a blessing because when it came to fighting Delta Dental and being vocal against some of their practices, I didn’t have to fear retaliation for speaking out against them. Additionally, I didn’t have to discount my rates. I had the liberty to donate a lot of services. Quite honestly, when it comes down to someone who is in pain and needs a tooth taken out, any dentist would donate the care. For me, my biggest thing was at least offering the preventative service and getting people out of infection or pain.”
Elected to office
Cathy Dahlquist, a former state representative who is now Executive Director for the Seattle-King County Dental Society, remembers meeting Caldier for the first time. “I was taking a tour of the UW School of Dentistry. At the time, I was an elected Washington state representative, and my nephew was planning on attending the school in the fall of that year. Dr. Caldier and I ended up going to lunch because she wanted me to hear about the program she had created to treat the elderly who were living in nursing homes. I listened intently and took her message of the need to reinstate adult dental Medicaid back to Olympia. She did not give up. She visited Olympia several times that session, and we worked together to successfully bring back the program.” Dahlquist and others convinced Caldier to run for office, based on the strength of her conviction to fight for the underserved. Since being elected, Caldier has used her platform to advocate for vulnerable populations like foster children, the developmentally disabled, and the elderly, prioritizing education, fighting unfair insurance practices, and advocating on behalf of her constituents and organized dentistry. She helped defeat legislation that would have allowed for midlevel practitioners in the state, and continues to work to raise reimbursement rates for adult dental Medicaid and change its prior authorization process.
The legislation that Caldier is most proud of is the bill requiring nonprofit insurance companies with paid boards to have the salaries of the CEO and the five highest-paid employees determined by the ratepayers. Caldier said this legislation shines light on some of the practices of the big insurance companies. “For instance,” she explained, “Delta Dental was paying Executive Director Jim Dwyer $1.3 million, and in two years it went up to $2.7 million. Delta Dental would justify its actions by saying that they had a study done showing that it was okay to increase his salary by that amount, yet at the same time, their board was also being paid, and one of the board members was making $480,000 a year, according to the IRS.” Caldier noted that many state legislators had no idea what was happening in the insurance industry, and she was proud to be the one to “…shoot an arrow into some of the most egregious things that Delta Dental was doing….” Rep. Liz Pike, R-Camas, said, “Since being sworn into office, Rep. Caldier has prime sponsored bills on fair dental insurance practices, reforming Medicaid prior authorization processes, requiring ratepayers to establish chief executive officer and board salaries for nonprofit insurance companies, and requiring dental insurance companies to be transparent with their communication to patients in their explanation of benefits form. One of Rep. Caldier’s greatest assets is her ability to stay focused on the issues and work across the aisle to get things done. She is highly respected by both Democrats and Republicans in Olympia. During that process, she is continually advocating to legislators on a variety of dental issues. And her work does not end when session is over. She is working on behalf of her constituents and dentistry all year long.”
Caldier has much to be proud of, including her work on behalf of her constituents, which has helped bring $42 million to her district, funding transportation projects and supporting environmental issues, and her efforts behind the scenes to help constituents that most people never hear about. But serving as a legislator doesn’t mean you always get your way, no matter how hard you fight. Caldier said, “As a dentist, I would write a treatment plan, and I would accomplish it. And every now and then, the patient behavior was different, so you had to modify the plan. In Olympia, you write what you’re going to do, you make a plan, but you have 146 other people you have to work with, and that’s just the legislators. That doesn’t include the lobbyists or anyone else. It’s five steps forward, four steps back. Whereas in private practice, you can make five steps forward, and maybe every now and then you have to take a step back. Olympia is slow-moving because there are so many things in play, and you don’t always get a win. There were more than 4,000 bills introduced during the 2017–18 biennia, and since 2018 was the first year that the Democrats had control of the Senate in five years, all of the Democrats had bills that they wanted put forward. It was intense, and it meant that even great bipartisan bills like my sexual assault bill didn’t go through, while some bills of little substance did.”
Leaving dentistry to focus on being a legislator
As you might imagine, balancing the work of a state representative and a dentist can be very tough. “A lot of people told me doing both would be manageable, but in the end, my duties in the Legislature didn’t stop when the session was over,” Caldier said, with a laugh. “Once I was elected to office, from January to May, I had only five days that I wasn’t working more than 14 hours. It was incredibly difficult navigating the dental practice with my position as legislator. The nice thing was that my practice was already established, so there was somewhat less work than when I first started practicing. I find it hard to imagine that someone in private practice could do both jobs.” In fact, Caldier retired from dentistry in 2016. Regardless, she remains as devoted as ever to fighting for organized dentistry. Oda, who is delighted she’s staying put, said “Our state would be a far better place if it had more citizens, and particularly more leaders, like Michelle Caldier. She labors tirelessly and selflessly for others, is scrupulously honest, always tries to do the right thing, believes the government should be transparent and serve its constituents, and sets a lifelong example of helping the state’s most vulnerable. Her ethics are stainless and her reputation is above reproach.”
Bringing the voice of dentistry to Olympia
Dentists around the state celebrated Caldier’s election in 2014 (she took office in 2015). From midlevel providers, to insurance regulation, to Medicaid coverage, dentistry has long lacked a voice in the Legislature. Pauley said, “Having Dr. Caldier in elected office with her expertise in the dental field is a luxury that patients across the state will be forever grateful for.” As a member of the Health Care Committee (she also sits on the Education and Appropriations committees), Caldier brings her unique perspective to the discussion on medical and dental issues. Legislators are constantly being bombarded with conflicting messages from paid lobbyists, and others have their own agenda, making it difficult to navigate and discern facts versus spin, according to Caldier. Case in point: the legislation being proposed to curb opioid abuse in the state. There is a lot of pressure on legislators to do something about the crisis, and myriad stories about opioid addiction and dentists’ role in the crisis crowding the news don’t help. “But it’s important that whatever legislators do, it is well thought out, and that we look at how that could impact everybody,” Caldier said. “Some people proposed that prescribers give a three-day supply or a pill limit of 10. As one of few members in the Legislature who has ever prescribed opioids, I was fighting to make sure that whatever we put forward took other situations into consideration. For instance, how would a three-day limit affect someone with chronic pain? How do we make sure we’re not lumping all opioids together? There is a huge difference between a fentanyl patch and Robitussin AC, yet Robitussin AC is an opioid, something most Legislators didn’t realize. If we have a pill limit, there is a difference between prescribing for someone who weighs 100 pounds versus 300 pounds. What about people who have just had major surgery and can’t go in every three days? It’s a very complicated issue, and I think it’s important to look at all of the pieces of the puzzle, not just one piece of the data. I felt like I did a great job of being at the table, and when some people would put forward very extreme ideas, I was able to counteract their argument. Sometimes we hear a story and we want to react, but if we do that, there could well be unintended circumstances.”
Back in the foster system and in the running
This year, Caldier added even more to her plate: she’s going to participate in the foster system again. Caldier let her license lapse years ago because of her frustration with the children’s administration when she was caring for her second foster daughter. “I needed a break,” she explained. “And now that we’ve passed some of these large pieces of legislation like HB 1855 which waives local requirements for foster children, many of those problems that frustrated me have been solved. I won’t be able to do long-term care because my work in the Legislature takes so much time, but I can do respite care for other foster parents, which gives them a short-term break from the foster children in their care. I want to see on the ground floor how the policies we’ve implemented work in a real-world setting. As legislators, we sometimes pat ourselves on the back for the work we do, but then what happens in the real world is totally different. I want to make sure that what we’re passing is actually being executed for the people who are taking care of our foster youth.”
Additionally, Caldier is running for re-election this year, and while she’s facing challengers, she’s resolute. She said, “I remember what it felt like to not have a lot, and to be judged. I also remember what it felt like when people went out of their way to fight for me. And that’s the thing. Throughout my childhood, when things were really tough, some negative people told me I would never make it in life. They didn’t expect me to graduate, and they thought it was funny that I wanted to be a dentist. But I also had a lot people who took the time to get to know me and support me. I want to be here for the people who may not have a champion fighting for them.”
Congratulations Rep. Caldier, we’re proud to have you as our Citizen of the Year!
